Monitor 2016: Taxpayer's Investment.

Looks like all the shares you bought in Foundation Trusts will be protected until 2016!!!

Shares? What Shares? It’s Taxpayer’s Investment. You do not get shares!!!

HSJ:

Monitor's transitional role could be extended beyond 2016

1 Sept., 2011

Monitor’s existing regulatory powers over foundation trusts could be extended beyond March 2016, under plans set out by ministers today.

Amendments to the Health Bill published today say that the regulator’s “specific intervention powers” will be retained for all foundation trusts until March 2016, with the health secretary gaining power beyond that period.

Previous versions of the bill would have applied the powers for two years, and only to some trusts.

The extension is in line with recommendations by the NHS Future Forum, to give foundation trust governors the time to build capability in holding their board to account, and to enable Monitor to protect the taxpayer’s investment in foundation trusts. 

Monitor: All recent posts.

The Cockroach Catcher: Monitor & Clause 56 1(a): Competition & Cartel

May 11, 2011

In The Guardian:

“……Tom Clark our leader writer says the real problem with the bill is the fact that the new regulator has a duty to promote competition where appropriate. He points out that in a previous life as a special adviser the regulator used his powers to squeeze state bodies in order to open up the space for private providers. It's why he is so against competition.”

For my money, the most important line in the whole of the health and social care bill is found – if I have the chapter and verse citation system right – at clause 56 1(a). It lists the first duty of the regulator Monitor, which is being transformed from the Foundation Trust hospital's overlord into being the economic regulator of the whole healthcare market, as being "promoting competition where appropriate".

The Cockroach Catcher: David Cameron & Mental Illness: Monitor & Bupa

May 03, 2011

Oooops, did I say monitor? Yes, Monitor may be re-launched as a QinetiQ styled company as there is so much money to be made from fining NHS Foundation Trusts. Dr David Bennett is not a medical doctor. ...

The Cockroach Catcher: NHS & Monitor: Eggs & Enron.

Mar 06, 2011

How many scientists do they have and indeed how many doctors do they have at Monitor or do they all have to have MBAs. Instead we had 100 million fake eggs. They are not even changing the name of DEFRA this time. ...

Sonia Brown: I think we can identify areas where we can see that the Department’s analysis has not gone to the point of being able to quantify the numbers. A really good example of that is that the NHS tends to treat much more complex cases. At the moment, the NHS is rewarded at the same rate for doing that as the private sector is for treating less complex cases. 

The Cockroach Catcher: Monitor & Lansley: Numeracy & Listening Skills

Apr 04, 2011

Q466 Grahame Morris: My question is in relation, Secretary of State, to the role and the costs of Monitor. On 8th February, I received a written answer about the costs of the new economic regulator which were estimated ...

Why spend £500 million on an economic regulator-and the figures were revised last week-if we are not going to have price competition?

The Cockroach Catcher: Quantum & M: Penny & Monitor

Apr 11, 2011

Q 195 Jeremy Lefroy (Stafford) (Con): I have a couple of questions about the role of Monitor. The first is about the Mid Staffordshire trust into which the Francis inquiry is looking at the moment. It seems to me as the local Member of Parliament that Monitor approved the foundation trust status without going into sufficient detail as to the status of that trust, particularly the quality of care at the time. What assurances can you give us that Monitor’s approval of foundation trusts will be more rigorous in the future than it was in the case of Mid Staffordshire? 

The Cockroach Catcher: NHS & Monitor: Inside Job & Trojan Horse

Mar 20, 2011

Tory MP and practising GP Sarah Wollaston has set out why she wants her own party to drop plans for a radical reorganisation of the National Health Service.

“It is not Greeks that could destroy the NHS, but if Monitor, the new economic regulator, is filled with competition economists with a zeal for imposing competition at every opportunity, then the NHS could be changed beyond recognition.

It is no use "liberating" the NHS from top down political control only to shackle it to an unelected economic regulator.”

The Cockroach Catcher: NHS & Monitor: Toyota & McKinsey

Mar 11, 2011

Q115 Rosie Cooper: Yes, if I may. Under the Bill, the Secretary of State will no longer have a statutory duty to provide health services and will only have to act with a view to securing the provision of health services in relation to the Board. How accurate is it to see this as spelling the end of a state provided National Health Service?

Nigel Edwards: That is precisely what it is, is it not? That is what it says. It is there in black and white. That is my reading of it as well. In fact, when every NHS hospital is a foundation trust, apart from the fact that the state would be a residual owner of roughly £36 billion of assets which belong to the taxpayer, there is no direct state control over the provision of health care except indirectly through the commissioning process. That is my reading of it.

The Cockroach Catcher: NHS Posts: Monitor, A & E, Parliament ...

Apr 25, 2011

NHS & Monitor: Accountants, A & E & Disasters. Thursday, March 17, 2011. Dr Bennett: On the armies of accountants point, Anna is right that one of the things that is needed is a more detailed and even clearer ...

The Cockroach Catcher: NHS & Monitor: Accountants, A & E & Disasters

Mar 17, 2011

…….Dr Bennett: On the designation question, the issue there is what happens if the provider of the service is the only provider of that particular service that is available to its local community but the provider gets into difficulty. ……………..If you finish up in a situation where you define the boundaries around A&E as being the whole of the DGH, then you have somewhat frustrated the policy, but I don’t think that should be necessary.

The Cockroach Catcher: NHS & McKinsey: FSA & Monitor

Mar 05, 2011

Trust!

Emily Thornberry:  I am tempted to press you further, David, given the profound implications of what you said in relation to work force pensions. We are about to pass this legislation and you are saying, “Take it on trust, as it will all be sorted out.” But we are talking about millions of people’s pensions here, and it is difficult not to push you at this stage. 

Worse than that, you said in an incomplete answer earlier that there were other obvious distortions and advantages that the NHS had over the private sector. I wonder whether you could list anything else, on top of pensions, that you might think might of? 

Shadow Elite: Public-Private Players & The NHS

Monday, June 27, 2011

"The new breed of players," writes Wedel, "who operate at the nexus of official and private power, cannot only co-opt public policy agendas, crafting policy with their own purposes in mind. They test the time-honored principles of both the canons of accountability of the modern state and the codes of competition of the free market. In so doing, they reorganize relations between bureaucracy and business to their advantage, and challenge the walls erected to separate them. As these walls erode, players are better able to use official power and resources without public oversight."

Dr David Bennett is the current head of Monitor (a sort of health FSA!) He is not a medical doctor. He

 was a Director at McKinsey & Co. In his 18 years with McKinsey he served a wide range of companies in most industry sectors, but with a particular focus on regulated, technology-intensive industries.

NHS Reform: Fragmentation & Dis-integration

There is much “intertwining” in the natural world: can we learn from it?

Brittle Sea Star©2010 Am Ang Zhang

It is not difficult over the New Year period for anyone in the NHS to see how the internal market has continued to fragment our health service.

Look at major hospitals in England: Urgent Care Centres are set up and staffed by nurse practitioner, emergency nurse practitioners and GPs so that the charge by the Hospital Trusts (soon to be Foundation Trusts)  for some people who tried to attend A & E could be avoided. It is often a time wasting exercise and many patients still need to be referred to the “real” A & E thus wasting much valuable time for the critically ill patients and provided fodder for the tabloid press. And payment still had to be made. Currently it is around £77.00 a go. But wait for this, over the New Year some of these Centres would employ off duty A & E Juniors to work there to save some money that Trusts could have charged.

College of Emergency Medicine

Urgent Care Centres are one of the most contentious parts of the NHS reforms. Both the College and the King’s Fund have consistently questioned the evidence base and the clinical and cost effectiveness for this major policy change2 3. Surprisingly many of the NHS pathway groups still recommend such units. The public will be very confused by the desire of some Primary Care Trusts (PCTs) to re-name the ED as an “Urgent Care Centre” for ambulatory patients.

The perceived problem that PCTs are trying to solve

There is a perception that many patients attending the ED should be treated in primary care. The College’s view is that a relatively small number are clearly non-urgent primary care problems that should have been seen by their general practitioner. A larger group of patients with urgent problems could be seen by primary care if there was timely access to the patient’s GP or out-of-hours services - e.g. at weekends. The College believes that improving access to GPs is the best way of dealing with this issue. At most we think that 25% of ED patients might be treated by general practitioners in an ED setting. There is no evidence to support the contention that 50-60% of ED attendances can be treated in Urgent Care Centres.

The approach of setting up an urgent care centre in front of every ED is an example of demand management. This has already been shown to be unsafe when tried in the USA.

Intertwined?

This is certainly not how Kaiser Permanente would run things: all integrated and no such thing as “cross charging”. In fact the doctors are not on a fee-for-service basis but like Mayo Clinic, Cleveland Clinic and Johns Hopkins Hospital, doctors are paid a salary.

I quoted Prof Waxman in an earlier post:

The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford, when it is not Oldham or Oxford that pays the bill — there is only one person that picks up the tab: the taxpayer, you and me.

And there are big problems with the billing process. For example, if a patient is seen in an outpatient clinic then there is a charge made by the hospital for his or her first attendance — but follow-up appointments are not charged. And if many treatments are given in a hospital to a patient, only the most expensive of the treatment episodes is charged.

There are savings to be made. It is alleged that there are just 75,000 administrators at work in the NHS but this figure is laughably mythological.

One report by the Centre for Policy Studies published in 2003 indicated that there were 250,000 administrative staff employed in the NHS: at least one administrator for every nurse.

……..Moving patients from one place to another does not save the nation’s money, though it might save a local hospital some dosh. So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice.

So as lead Consultants face the managers in meetings after the New Year festivities about the White Paper and Foundation Trust status and how we need to copy Kaiser Permantente, there is no need to talk about the 24 % “illest” that Kaiser did not treat, instead raise the points about a truly integrated NHS, in Kaiser Permanente fashion.

Just do away with our internal market and let GPs and Consultants go back to the good old days of working together without worries about  PCT/Commissioner’s approval of the referral.

Integration not fragmentation!

Prof Waxman:

…….Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition.

"Whatever the benefits of the purchaser/provider split, it has led to an increase in transaction costs, notably management and administration costs. Research commissioned by the DH but not published by it estimated these to be as high as 14% of total NHS costs. We are dismayed that the Department has not provided us with clear and consistent data on transaction costs; the suspicion must remain that the DH does not want the full story to be revealed. We were appalled that four of the most senior civil servants in the Department of Health were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts. We recommend that this deficiency be addressed immediately. The Department must agree definitions of staff, such as management and administrative overheads, and stick to them so that comparisons can be made over time."

                                                                                                     House of Commons

                                                                 

Enemy Of The People: NHS, Internal Market & Safety Net

For ‘Liberating the NHS’ read ‘Dismantling the NHS’

The internal market has been a costly disaster. Let the professionals manage medicine 

Mayo Clinic: Health Care is not a Commodity!!!

The NHS & Southern Cross Healthcare: The future is now!!!

The Cockroach Catcher: NHS: Circle to Serco

NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

Related:

NHS-Kaiser Permanente: Integration?

NHS-Kaiser Permanente: The Good Bits!!!